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What is Presentation State? A “recipe” describing a particular presentation (display) of a data object. According to DICOM, 2D Presentation State includes capabilities for specifying: the output grayscale space in P-Values the color output space as PCS-Values grayscale contrast transformations including modality, VOI and presentation LUT mask subtraction for multi-frame grayscale images selection of the area of the image to display and whether to rotate or flip it image and display relative annotations, including graphics, text and overlays the blending of two image sets into a single presentation 2

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2D Example: Blending Presentation State Pipeline 3

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Application of Presentation State Data objects may contain certain attributes as a “default Presentation State” A separate Presentation State object referencing the data object overrides the default presentation state attributes within the referenced data object 4

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Enhanced DICOM Objects change the game Many modalities have created “Enhanced” data objects which allow the specification of 3D and 4D data sets (MR, CT, XA, PET, US, …) These 3D/4D datasets may be presented (viewed) as A collection of spatially-related frames Displayed one at a time, as in a light box display Sequentially, in “fly-through” display A Multi-Planar Reformatting (MPR) view, which is a derived slice obliquely through the volume dataset Volume Rendering, which is a view of the volume dataset from a specified viewport and orientation 5

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Example: Ultrasound Display 3 MPR + Volume Rendering Views 6

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3D Workflow These derived views may be exchanged as 2D objects linked to the source volume data objects Need a way to represent the “recipe” for creating these 2D views of volume data objects so the viewing operation may be replicated on a different system and/or at a different time 7

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Example 3D Image Review Workflow Clinician reviews a 2D derived view on a PACS Decides to reposition the slice or viewport or change processing 2D object links to the Presentation State object, which provides the recipe and a link to the source volume data Workstation uses the recipe to regenerate the same 2D view Clinician uses workstation controls to modify presentation parameters starting from the same point as the original 2D view 8

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What’s happening within DICOM working groups Working Group 11 (Presentation State) has a work item to create a general (not modality specific) n-Dimensional Presentation State object Working Groups 2 (X-Ray Angiography) and 12 (Ultrasound) are collaborating Need to understand use cases and requirements for all DICOM imaging modalities Other imaging modalities need to participate if they want a say in the creation of nD PS objects 9

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Call for Participation In the best interest of vendors and clinicians for all modalities to participate Desired minimum level of participation Use Cases Requirements Test Cases Better Participate in Derivation of the Standard 14